"KBenefits Learning Center"

Categories:

Health Insurance 101

• Deductible: Amount you pay before insurance starts paying.
• Copay: Fixed amount you pay for a service or prescription.
• Coinsurance: Percentage of the cost you pay after your deductible.
• Out-of-Pocket Maximum: Most you pay in a year for covered services.
• EPO: Requires you to use in-network providers and no referrals required.
• PPO: Offers more flexibility to see in-network and out-of-network providers. No referrals required
• Network: Doctors, hospitals, and providers contracted with your insurance company.
• Premium: Monthly cost you pay for your health insurance.
   

Small Business

• When Can a Small Business Offer Coverage? Small businesses with 2 or more eligible employees can offer coverage the 1^st or 15^th of any upcoming month, subject to carrier requirements and enrollment rules.
• Fully Insured: The employer pays premiums to an insurance carrier, which assumes the claims risk.
• Self-Funded: The employer pays employee medical claims and assumes the financial risk. Employers purchase additional stop-loss insurance to eliminate financial risk, often using an administrator.
• Small business health plans have more options, flexibility and competitive premiums than Individual market plans

Medicare

• Turning 65: Age when most people become eligible for Medicare.
• Medicare Part A: Covers inpatient hospital stays, skilled nursing care, and some home health care.
• Medicare Part B: Covers doctor visits, outpatient care, and preventive services.
• Medigap: Supplemental insurance that helps pay costs Medicare doesn't cover.
• Medicare Advantage (Part C): Private insurance that replaces Original Medicare and combines Part A and Part B coverage.
• Medicare Part D: Helps cover the cost of prescription medications.

NJ Health Insurance

• GetCoveredNJ: New Jersey's official health insurance marketplace where individuals and families can shop for coverage and apply for financial assistance.
• Open Enrollment: Annual period when individuals can enroll in or change health insurance plans.
• Special Enrollment Period (SEP): Allows you to enroll in or change coverage outside Open Enrollment after qualifying life events.
• Medicaid/NJFamilycare/CHIP: Government programs providing free or low-cost health coverage to eligible low-income individuals, families, children, and pregnant women.